Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
Department of Research, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
Abdom Radiol (NY). 2024 Sep;49(9):3117-3126. doi: 10.1007/s00261-024-04333-5. Epub 2024 May 21.
To validate the diagnostic performance of adrenal washout CT in patients without known malignancy in a Western Australian population.
A radiology information system (RIS) search for CT reports containing "adrenal" and "washout" across six networked metropolitan public hospitals between January 2005 and November 2021. Homogenous nodules ≥ 1 cm, ≥ 10 HU without a suspected functional component in patients without a history of malignancy were included. Reported absolute and relative washout percentages were recorded and re-measured from unenhanced, 60-s portal venous and 15-min delayed phase imaging and compared to either histopathological or CT follow up for growth (≥ 12 months) reference standards.
2653 studies were screened with 191 meeting inclusion criteria. 105 nodules underwent washout CT and then had either histopathological (12 patients) or CT follow up (93 patients) reference standards available. Reported absolute washout (aWO) estimated sensitivity and specificity for malignant/indeterminate nodules was low at 33% (95% CI 25-43%) and 77% (95% CI 68-84%) respectively. Reported relative washout (rWO) sensitivity and specificity were 56% (95% CI 46-65%) and 69% (95% CI 60-77%) respectively. Negative predictive values for both aWO and rWO were reassuring at 92% (95% CI 86-96%) and 94% (95%CI 88-97%).
Our study validates a recent report suggesting that adrenal washout has poor sensitivity for and consequent limited utility to exclude malignancy in patients with no cancer history. However, patients with incidental adrenal nodules < 4 cm in size with benign washout can be reassured by the high negative predictive value and worked up to exclude functional adenoma and re-imaged in a year to confirm no growth.
在西澳大利亚人群中验证无已知恶性肿瘤的患者中肾上腺洗脱 CT 的诊断性能。
对 2005 年 1 月至 2021 年 11 月期间在六家联网的大都市公立医院的 CT 报告进行放射学信息系统 (RIS) 搜索，以查找包含“肾上腺”和“洗脱”的 CT 报告。纳入无恶性肿瘤病史且均质结节≥1cm，≥10HU 且无可疑功能成分的患者。记录报告的绝对洗脱率和相对洗脱率，并从未增强、60 秒门静脉期和 15 分钟延迟期成像中重新测量，并与组织病理学或 CT 随访的生长（≥12 个月）参考标准进行比较。
共筛选了 2653 项研究，其中 191 项符合纳入标准。105 个结节进行了洗脱 CT 检查，然后有组织病理学（12 例）或 CT 随访（93 例）参考标准。报告的恶性/不确定结节的绝对洗脱（aWO）估计敏感性和特异性分别为 33%（95%CI 25-43%）和 77%（95%CI 68-84%）。报告的相对洗脱（rWO）的敏感性和特异性分别为 56%（95%CI 46-65%）和 69%（95%CI 60-77%）。aWO 和 rWO 的阴性预测值分别为 92%（95%CI 86-96%）和 94%（95%CI 88-97%），令人放心。
我们的研究验证了最近的一项报告，即对于无癌症病史的患者，肾上腺洗脱对恶性肿瘤的敏感性差，因此对排除恶性肿瘤的作用有限。然而，对于大小<4cm 的偶然发现的肾上腺结节且洗脱良性的患者，可以通过高阴性预测值来安心，并排除功能性腺瘤并在一年内重新成像以确认无生长。
